title: Realizing improved patient care through human-centered operating room design: a human factors methodology for observing flow disruptions in the cardiothoracic operating room.
abstract: BACKGROUND
  Human factors engineering has allowed a systematic approach to the evaluation of adverse events in a multitude of high-stake industries. This study sought to develop an initial methodology for identifying and classifying flow disruptions in the cardiac operating room (OR).
  
  
  METHODS
  Two industrial engineers with expertise in human factors workflow disruptions observed 10 cardiac operations from the moment the patient entered the OR to the time they left for the intensive care unit. Each disruption was fully documented on an architectural layout of the OR suite and time-stamped during each phase of surgery (preoperative [before incision], operative [incision to skin closure], and postoperative [skin closure until the patient leaves the OR]) to synchronize flow disruptions between the two observers. These disruptions were then categorized.
  
  
  RESULTS
  The two observers made a total of 1,158 observations. After the elimination of duplicate observations, a total of 1,080 observations remained to be analyzed. These disruptions were distributed into six categories such as communication, usability, physical layout, environmental hazards, general interruptions, and equipment failures. They were further organized into 33 subcategories. The most common disruptions were related to OR layout and design (33%).
  
  
  CONCLUSIONS
  By using the detailed architectural diagrams, the authors were able to clearly demonstrate for the first time the unique role that OR design and equipment layout has on the generation of physical layout flow disruptions. Most importantly, the authors have developed a robust taxonomy to describe the flow disruptions encountered in a cardiac OR, which can be used for future research and patient safety improvements.
authors.affiliation: * Doctoral Candidate, ‖ Associate Professor, Department of Industrial Engineering, Clemson University, Clemson, South Carolina. † Associate Professor, Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, and Adjunct Associate Professor, Department of Industrial Engineering, Clemson University. ‡ Graduate Student, § Professor/Director, Graduate Program in Architecture and Health, School of Architecture, Clemson University. # Professor and Chair, Department of Industrial Engineering, Clemson University, and Human Factors and Systems, Embry-Riddle Aeronautical University, Daytona Beach, Florida. †† Professor and Chairman, Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina.
authors.forename: Gary
authors.initials: G
authors.lastname: Palmer
authors.forename: James H
authors.initials: JH
authors.lastname: Abernathy
authors.forename: Greg
authors.initials: G
authors.lastname: Swinton
authors.forename: David
authors.initials: D
authors.lastname: Allison
authors.forename: Joel
authors.initials: J
authors.lastname: Greenstein
authors.forename: Scott
authors.initials: S
authors.lastname: Shappell
authors.forename: Kevin
authors.initials: K
authors.lastname: Juang
authors.forename: Scott T
authors.initials: ST
authors.lastname: Reeves
mesh_terms: D001108:Architecture; D003142:Communication; D004738:Engineering; D004779:Environment Design; D004868:Equipment Failure; D005160:Facility Design and Construction / Q000379:methods*; D006801:Humans; D009726:Nurses; D009873:Operating Rooms / Q000458:organization & administration*; D010564:Personnel, Hospital; D010820:Physicians; D013523:Surgical Equipment; D009626:Terminology as Topic; D013903:Thoracic Surgery / Q000458:organization & administration*; D057188:Workflow